Clinical Pharmacy Technician I-Wexford-Hybrid

1 week ago

Wexford, United States Highmark Health Full time
Job Summary

This position supports the network centralized prior authorization department, ensuring the effective and efficient processing of pharmacy benefits prior authorization. The successful candidate will coordinate and administer the prior authorization process, adhering to all regulatory agency requirements.

Key Responsibilities
  • Reviews pharmacy utilization management (UM) coverage requests and prepares cases for clinical review by a pharmacist and/or medical director when required.
  • Applies plan-specific benefits to each case, summarizes pertinent facts, and cites applicable internal policies and guidelines.
  • Resolves non-clinical issues independently and acts as a liaison between customer and provider-facing teams and the Corporate Pharmacy Department.
  • Maintains regulatory compliance and resolves all cases within predetermined timeframes.
  • Responsible for all preauthorization entries into applicable databases to ensure swift and appropriate payment of services deemed medically necessary.
  • Engages in member and provider outreach to resolve non-clinical issues such as appeal initiation requests, processing errors, and fulfilling notification requirements.
Requirements
  • 2 years of experience as a Pharmacy Technician in a hospital, retail, or managed care setting.
  • Certified Pharmacy Technician (CPhT) from Pharmacy Technician Certification Board.
Preferred Qualifications
  • Strong knowledge of medical and pharmaceutical terminology.
  • Strong verbal and written communication skills.
  • Well-organized, paying close attention to detail.
  • Ability to identify and resolve problems.
  • Ability to handle multiple priorities in a timely manner.
  • Strong interpersonal skills.
  • Ability to work independently or in a team environment.
  • Customer-oriented.
  • Proficient with Microsoft Office products.
Disclaimer

The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

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